Choosing A Scar

[jleeb]

I recently consulted two plastic surgeons about gynecomastia surgery. Unfortunately I have a more severe case (Weighed 350lbs by 15, lost 150) and have a lot of loose skin that needs to be removed and there will be a visible scar. I am having a difficult time deciding which surgeon to choose because they described different incisions and scars. While they both mentioned the incision around the areola the first explained a scar extending down from the areola and across. The other described extending from nipple towards the armpit. I'm not thrilled with either option but the second doctor explained that he preferred the scar extending from the nipple towards the armpit because he thought it looked better on males. I have attached a quick drawing of what I understand the scars to look like based on their explanation. I was wondering if others had similar preferences or opinions about which scars look best or the "least worst".

[Dr. Elliot Jacobs]

Very difficult to offer an opinion without photos.  However, in general, I prefer the fewer scars the better.  The first illustration is the classic set of scars used for a female breast reduction.  In my mind, this approach should not be used on a male.

Dr Jacobs

[jleeb]

Here are a couple of photos. I'm not sure how to make them bigger with the file size limit. Both doctors stated that there was not much fat, just skin. As you can see, it's a fairly severe case and there will most likely be a scar. It's just a question of where and how bad.

[Dr. Elliot Jacobs]

Thanks for the photos.  You are a classic case of massive weight loss in which the stretched out skin has nowhere to go -- so it droops.  You may still have some breast tissue, albeit condensed since the intervening fat has diminished substantially.

You will require reconstruction to achieve a trim tight chest with smaller nipples located at a more normal position.  There are a number of ways to do this -- but all will leave scars.  The scars are a trade-off for a better and more comfortable "birthday suit."

Suggest you visit several plastic surgeons and ask about the nuances of their individual approaches and techniques -- some may leave fewer scars than others.  One of my favorite techniques is illustrated as patient 80a,b on my website (see below).  It involves a scar around the edge of the nipple as well as a scar along the fold beneath the breast (which may extend onto the side of the chest if there is loose, hanging skin there).

Best of luck!

Dr Jacobs

[jleeb]

Thank you for the photo. I also think that patient 83 is close, if not closer but I guess he has the benefit of being a bodybuilder. I believe the scars on these men are probably the same type the Doctor was trying to describe to me. It definitely helps to visualize it. Though visible it seems that they don't look completely out of place and blend into the body's contours. Thanks for the photos, they've helped make the decision clearer.

[Dr. Elliot Jacobs]

You are welcome -- let us know how your search and eventual surgery turn out!

Best of luck.

Dr Jacobs

[DrPensler]

This is not gynecomastia but more accurately reconstruction following massive weight loss.

[jleeb]

This is not gynecomastia but more accurately reconstruction following massive weight loss.

That makes sense though gynecomastia I guess has been used broadly by some of the Doctors and sites that I have found to encompass this. It explains why most of the before and after photos have not accurately reflected my situation which is another reason I'm grateful for Dr. Jacob's photos because they have one or two patients to whom I can relate. It's difficult not knowing what to expect!

[Litlriki]

I also prefer the approach Dr. Jacobs uses with an incision that is located in the fold below the breast and an incision around the areola for patients like yourself after massive weight loss.  The scars tend to fade nicely over time, and they are predominantly located in positions which are natural. 

Good luck,

Rick Silverman

[jleeb]

I also prefer the approach Dr. Jacobs uses with an incision that is located in the fold below the breast and an incision around the areola for patients like yourself after massive weight loss.  The scars tend to fade nicely over time, and they are predominantly located in positions which are natural. 

Good luck,

Rick Silverman

Thank you, Dr. Silverman. Do you specialize in gynecomastia/reconstruction? I'm actually in Brighton/Newton for school but plan to have the procedure in my hometown of Cincinnati, OH since I'd imagine the costs in Boston are slightly higher. I have not heard a great deal about the surgeons in Boston but I'm intrigued to see one so close.

[Dr. Elliot Jacobs]

You would be wise to consult with Dr. Silverman since he is so close to you and is a recognized gyne specialist.  At the very least, you would receive some expert opinion -- it would be well worth the cost of his consultation.

While there are excellent surgeons all around the country, I would very strongly suggest that you not make your choice of surgeon based on cost alone.  A good result will last a lifetime -- and long after the initial surgical fee is forgotten.  A bad result will provide you with a never ending nightmare, sleepless nights and additional costs to try to correct the problem if possible.  Do your research carefully -- this is elective surgery, not an emergency.  Choose the surgeon who makes you feel most comfortable and confident -- do not make your choice based on the fee alone.

Dr Jacobs

[Litlriki]

I'd be happy to meet with you to discuss the surgery.  Costs do vary around the country, in part subject to the cost of living and doing business in any given area, and Boston is a more expensive place to live and work than Cincinnati.  That said, although this is something I focus on in my practice, my fees are not the highest in the area, and they may not be much higher than what you might find at home. 

RS